Is Heart Transplantation An Option For Patients With Severe Angina Not Responding To Other Treatments?

May 2, 2008

Harlan Krumholz, M.D., S.M., Harold H. Hines, Jr. Professor of Medicine and Epidemiology and Public Health, Yale University School of Medicine

Question: Is heart transplantation an option for patients with severe angina not responding to other treatments?

Answer: The question of what to do with people who have severe angina -- that is, severe chest discomfort, or pains that are related to a reduced flow to the heart, and who have exhausted every possible intervention that could help them and are being told that they can't have bypass surgery and that they can't have angioplasty, and they're on all of the medications that they could possibly be on -- the question is, well, what about heart transplant?

Well, it's not a specific indication for heart transplant right now, but I do know that sometimes there are considerations and discussions around it, but in general, heart transplantation is not an option for these individuals. But, I will tell you this, there are no hard and fast rules anywhere about anything when it comes to you and your health, and these are the kind of discussions that you need to have.

If someone is truly debilitated, truly limited by their angina, such that they just cannot engage in any sorts of activities, that their ability to do almost anything is limited by these symptoms, and there are no other options for them, then I think it's worth discussing, and although this isn't the usual path for people to go. It's worth talking about, because it's a possibility, and it may be the only possibility. So from my perspective, if it's your health, never exactly take no for an answer when you really want to exhaust all possibilities, and this is something worth talking to your doctor about. But in general, it's very few people that actually end up in this situation.